UTILITY OF IN-VITRO FERTILIZATION AT DIAGNOSTIC LAPAROSCOPY

Objective: To compare stimulation and outcome variables for IVF in sti mulated cycles when ova are retrieved during diagnostic infertility la paroscopy versus transvaginal ultrasound (US) directed retrieval and t o investigate the presence of unexpected failed fertilization in the d iagnostic laparoscopy group, which allows an opportunity to diagnosis an etiology of infertility based on gamete interaction. Design: Consec utive patients who needed infertility diagnostic laparoscopy and agree d to combination with IVF were compared with concurrent patients under going transvaginal US IVF. Male factor screening parameters (semen ana lysis, sperm penetrating assay) and resultant fertilization were analy zed for these patients. Setting: The George Washington University Hosp ital, a tertiary referral center offering assisted reproductive techno logies. Patients for diagnostic laparoscopy combined with IVF were enr olled in the Program of Oocyte Retrieval at Diagnostic Laparoscopy (PO RDL). Participants: One hundred twenty-four women enrolled for diagnos tic laparoscopy combined with IVF; 237 women were concurrently enrolle d for transvaginal US IVF. Results: Response variables (number of foll icles, days of monitoring ampules of hMG, maximum E(2)) between the tw o groups were similar. Outcome variables (ova retrieved, ova fertilize d, ova cleaved, clinical pregnancy rate per embryo transferred) were s imilar despite a significantly higher number of embryos transferred fo r the transvaginal US group. The clinical pregnancy rate per cycle was similar, 26% versus 28% for the women in the transvaginal US versus t hose women in the PORDL group, as was the clinical pregnancy rate per ET, 31% versus 34%, respectively. The number of fertilized ova for eac h group was not significantly different: 5.5 +/- 0.3 for the transvagi nal group versus 4.8 +/- 0.4 for the PORDL group. Patients in the PORD L group with a known male factor (group B) had a lower fertilization r ate than those with no male factor (group A). Within the group A with no detectable male factor prospectively, 17.2% had unexpectedly poor f ertilization (group A(1)), whereas the rest of the group A patients ha d higher fertilization rates as was expected (group A(2)). The clinica l pregnancy rate per ET for group A(1) was 0% compared with 43.4% for the group A(2) patients. Conclusions: In vitro fertilization can be su ccessfully performed during diagnostic laparoscopy yielding comparable results to transvaginal ultrasound IVF while gaining diagnostic infor mation concerning sperm-ova interaction (i.e., fertilization).